Feeding problems, food refusal and selective eating — formative SAQs

SAQ 1 — Preschool selective eating with growth concern (10 marks)

A 3-year-old eats five foods, gags on mixed textures and has crossed two weight centiles downward over 8 months. Caregivers force spoonfuls at every meal. No cough with fluids and no body-image concerns. [1] [2]

Questions

1. Write a one-sentence problem representation and state whether this is likely ordinary neophobia, PFD and/or ARFID-pattern restriction. (3 marks) [1] [2] [3]
2. Map the active PFD domains and list three history or examination priorities today. (4 marks) [2] [6]
3. Give three immediate management steps for this week. (3 marks) [1] [2]

Model answer

Problem representation (3). Example: “Three-year-old with severe texture-limited diet, force-fed meals and falling weight trajectory over 8 months; clinically significant feeding disorder spanning nutritional and psychosocial domains with ARFID sensory-pattern features rather than ordinary self-limited neophobia.” Ordinary neophobia alone is unlikely once growth is clearly deteriorating. [1] [2] [3]

Domains and priorities (4). Active domains: nutritional (centile fall, narrow diet), psychosocial (force-feeding conflict), likely feeding skill/sensory (gagging on mixed textures); medical domain needs screening but no current cough with fluids. Priorities: full accepted-foods list and mealtime tactics; plot serial growth; examine oromotor status, hydration and micronutrient-risk signs; screen development/autism traits and organic red flags. [2] [6]

Immediate steps (3). Stop force-feeding and restructure meals/snacks with responsive feeding coaching. Urgent dietetic input to protect energy and micronutrients using accepted foods. Book early multidisciplinary feeding review and set concrete red flags for earlier return if intake collapses. [1] [2]